KEITH LODGE #23
“D.L.WOOD SCHOLARSHIP”
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The value of the scholarship is $1000.00.
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Completed applications must be sent to:
WB Richard Wood,
Keith Lodge Scholarship Chairman,
78 Ammon Road,
Moncton, NB, E1G 2K4
and postmarked no later than May 31st application year.
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Application open to any grade twelve student in the Anglophone East or Francophone South School Districts of N.B. planning to enroll in a recognized university or college in Atlantic Canada within 4 months of graduation from high school. Preference will be given to a student having a relative that is/was a member of Keith Lodge #23 in Moncton, N.B., however consideration will be given to those students who have assisted Keith Lodge activities in some way.
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Preference will be to a student pursuing studies in the health sciences, however favorable consideration will be given to all sciences, or other fields with a humanitarian connection.
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Recipient must provide proof of enrollment/attendance at the institution of higher learning before a cheque is issued.
APPLICATION FOR KEITH LODGE #23
“D.L. WOOD SCHOLARSHIP”
IN MEMORY OF BRO. VINCENT STEEVES
(PLEASE PRINT ALL REQUIRED INFORMATION)
FULL NAME: ________________________________________________ MALE: ____ FEMALE: ____
DATE OF BIRTH: DAY: ______ MONTH: ______ YEAR: _______
MAILING ADDRESS: _________________________________________
_________________________________________
_______________________ PC: ______ _______
PHONE: _____________________________________________________
EMAIL: _____________________________________________________
HIGH SCHOOL ATTENDING: _________________________________
HIGH SCHOOL PHONE NUMBER: _____________________________
CONNECTION TO KEITH LODGE #23 AS PER #3 ON INFO PAGE:
UNIVERSITY/COLLEGE: _____________________________________
FIELD OF STUDY: ___________________________________________
TO THIS APPLICATION, PLEASE ATTACH THE FOLLOWING THREE ITEMS:
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A SINGLE TYPED PAGE TELLING US WHAT WE SHOULD KNOW ABOUT YOU…. ACCOMPLISHMENTS?, EXPERIENCES?, AMBITIONS?, ACCOLADES?, AWARDS?, SKILLS?, AND ANY OTHER TRIVIA WHICH SAYS “WHO YOU ARE!”
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OFFICIAL TRANSCRIPT OF 1ST /2ND TERM MARKS.
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PHOTO WITH YOUR NAME ON THE BACK.
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